RTI Team Form
Please complete all questions in order for your request to bring a child to team to be process.
Email address *
Name of Child *
Your answer
Grade *
Teacher's Name *
Your answer
Last Year's Teacher *
Your answer
Student's Date of Birth *
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YYYY
Date Student Entered Barnard *
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YYYY
Check to indicate that you reviewed student's cumulative and confidential files. *
Required
Date parent was notified that their child is being brought up to the RTI Team *
MM
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DD
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YYYY
Describe how the student's academic and social strengths can be used to support interventions? *
Your answer
In what area are you seeking collaboration with the RTI team for this child? *
Required
What is the most pressing issue that is interfering with your student's ability to learn in the classroom? Please include examples. If applicable, please bring student work to your team meeting once scheduled. *
Your answer
Which interventions/strategies have you implemented in your classroom that are aligned to your concerns. For each intervention, please describe the results and include the start and end date of each intervention. *
Your answer
Other classes or areas in which you are concerned. Please select all that apply.
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